PASRR regulations at 42 CFR 483.128(m) permit Level II evaluations to be terminated if the Level II evaluator finds that individual has: “A primary diagnosis of dementia (including Alzheimer’s Disease or a related disorder)” (42 CFR 483.128(m)(2)(i)); or
States may apply the categorical determination at 42 CFR 483.130(h), to address a decision not to provide specialized services to individuals with dementia and intellectual disability. “(h) Categorical determinations: Dementia and ID.
The dementia exclusion for mental illness allows for the Level II evaluator to stop the evaluation if they determine that the diagnosis of dementia is primary and the mental illness (MI) diagnosis is secondary. It is important to note that the diagnosis or verification of a diagnosis of MI and...
It can often be difficult to determine where MI/ID ends and dementia begins. Like ID/DD, dementia can manifest as cognitive impairments. Like MI, dementia can lead to anxiety, depression, or acute behavioral problems.
Since the ICD-10-CM coding went into effect on October 1, 2015, some State PASRR programs have reported an increase in PASRR volume, particularly in referrals for Level II Resident Reviews. The increase is largely attributed to the computer algorithm that converted ICD-9 codes to ICD-10 codes.
The most recent version of the Review of State PASRR Policies and Procedures National Report was released in March 2017.
CMS recently updated its guidance on Specialized Services to clarify that Specialized Services can only be provided while individuals reside in nursing facilities. States are obligated to provide or arrange for the disability-specific services that individuals need while in NFs.
There is a common misconception about this. The simple answer is "no" -- a test of intllectual functioning is not required. Here's the reasoning, broken down into its components:
Oversight responsibility for Level I screens rests with the state Medicaid agency, although all involved parties are eligible to conduct the Level I screens, including nursing facilities, the state mental health authority, the state intellectual disability authority, or an independent entity (such...
Yes, hospitals can perform Level II evaluations -- provided they have the qualified staff. In order to complete these evaluations, hospitals would first have to negotiate payment rates with the relevant state agency.
The hospital discharge exemption is the only true exemption from the requirements of PASRR. The exemption applies to individuals who are discharged from a hospital into a Medicaid-certified nursing facility (NF) and their stay is expected to last no more than 30 days.
The July 2013 PASRR webinar took place on Tuesday, July 9 at 1PM Eastern (10AM Pacific) and featured Dr. Ed Kako, Director of the PASRR Technical Asisstance Center (PTAC) and Dan Timmel, PASRR policy director at the Centers for Medicare and Medicaid Services.
The Level I evaluation is the preliminary screen that identifies suspected intellectual disability, mental illness, or a related condition. The Level I screen is a vital “gatekeeper” to the process of identifying disability-specific needs and evaluating appropriate placement.
The CFR does not prescribe a particular method of conducting Level I evaluations, leaving states open to their own interpretations. In general, the Level I evaluation is based on pre-existing information, such as prior mental health diagnoses, and information gathered by the screener.
A PASRR Level I evaluation must be completed for all applicants to a Medicaid-certified nursing facility, regardless of payer. A Level I screen must be completed before a resident can be admitted into a nursing facility.
Claims for PASRR activities are submitted by the Single State Medicaid Agency to CMS on a quarterly basis via Form CMS-64.
Lines 10 and 11 of Form CMS-64 are used to claim the enhanced 75% match rate for PASRR-related activities. Specifically, a state should use line 10 to claim its “Preadmission Screenings Costs,” i.e. PASRR activities that happen before admission into a nursing facility.
Claiming the enhanced 75% match rate for PASRR-related activities means more than just completing Form CMS-64. States must also consider the following:
Only the share of time spent on PASRR-related activities can be claimed at the enhanced 75% match.
The Division of Cost Allocation (DCA) within the Program Support Center (PSC) approves states’ CAPs.